Latest / Radically Genuine / 180. The Myth of Safety in Maternal Medicine & the Propaganda Behind It w/ Dr. Adam Urato

Transcript

180. The Myth of Safety in Maternal Medicine & the Propaganda Behind It w/ Dr. Adam Urato · Radically Genuine

• Roger K. McFillin, Psy.D, ABPP (00:01.804) Welcome to the Radically Genuine Podcast. I'm Dr. Roger McFillin. When a woman becomes pregnant, she carries within her our most vulnerable population. An unborn child whose future development hinges on decisions made before they can speak for themselves. Yet our medical and regulatory systems repeatedly fail both mother and child in what can only be described as a catastrophic moral failing of our society. The history of medicine is littered with examples where pregnant women were assured treatments were safe, only to discover, often too late, that significant risks existed. This isn't merely a scientific oversight. It's a profound violation of human dignity. Every mother has a fundamental right to truly informed consent about what enters her body and potentially affects her child's development. When physicians and drug Regulators fail to thoroughly communicate risks, whether that's from pharmaceuticals, medical interventions, or vaccines. They deny women their autonomy and potentially sacrifice children's futures on the altar of medical convenience and even profit. What makes this betrayal devastating is that it targets the beginning of human life, a time of exquisite vulnerability when even subtle influences can have lifelong consequences. Our unborn children cannot advocate for themselves. They rely entirely on their mother's protection. And those mothers rely on complete and honest information from medical authorities. This isn't about promoting fear. It's about demanding transparency. It's about recognizing that withholding information about potential risks, even uncertain ones. represents an anti-human approach that treats pregnant women not as autonomous decision makers, but as vessels to be managed when we rush to establish consensus before sufficient evidence exists, when we dismiss legitimate concerns as unscientific, when we fail to conduct rigorous long-term safety studies, especially for pregnant women. Roger K. McFillin, Psy.D, ABPP (02:26.146) we betray the most sacred trust in medicine. For today's podcast, I'm honored to welcome back Dr. Adam Urato, who is a maternal fetal medicine physician in his hometown of Frangham-Hann, Massachusetts. He grew up in that town. He attended Harvard and Harvard Medical School. He did his OB-GYN residency at Massachusetts General Hospital and Brigham and Women's Hospital. His maternal fetal medicine fellowship was at Tufts Medical Center. He has an active clinical practice taking care of high-risk pregnancies and delivering babies. He writes and lectures on medication exposures in pregnancies. He has a extremely valuable ex-account where he's consistently posting this literature. He's something I check out. as regularly as I can. And I use that information to inform other women who are childbearing years or are currently pregnant. And he and I share same principles. We're both strong supporters of freedom of speech, medical freedom, and informed consent. We should all seek out debate when it comes to scientific controversies. And there are many. And unfortunately, just not enough people are receiving that information. Instead, you're just a passive consumer in this process. Dr. Adam Urato, I want to welcome you back to the Radically Genuine Podcast. Adam Urato (04:08.094) Well, it's a real pleasure to join you again. And the last time I was on here, I appreciated the opportunity to get the word out. And a lot of patients have since come to me and said, I saw you on that podcast. So I really appreciate the work that you do in this opportunity to kind of spread the word. I just wanted to pick up on something you said in the introduction, which is that I think it's critically important that in this topic for people to realize that It's not about, sometimes it gets spun as being about pill shaming or promoting fear, fear mongering. That's not what this is. Mental suffering, whether it's depression, anxiety or whatnot, is an awful place to be in. And so it's important to take good care of those patients. But I think a crucial component to compassionate care is proper counseling. That's a vital component to this. And so that's really the effort here is to get pregnant women and the public the right information about these medications, about different approaches so that they can make the best decisions for themselves. Roger K. McFillin, Psy.D, ABPP (05:10.926) Well said, well said. You have this pinned on your ex account. And I'd like to begin with this because it's a concrete example of systemic failure. For over a decade, a drug called, was it McKenna? Yeah. Was the only FDA approved drug to reduce preterm birth risk, right? And I think it's been prescribed to like over 350,000 women. Adam Urato (05:26.27) That's right, can, yep. Roger K. McFillin, Psy.D, ABPP (05:39.148) before the FDA finally withdrew approval in 2023 after studies showed that it simply didn't work. Can you explain to us what happened there and why you see this as part of a larger pattern where pregnant women are denied their right to make truly informed decisions about interventions that affect both them and their unborn child? And how could this have been prevented? Adam Urato (06:05.364) Yeah, I think McKenna is a great example of what's wrong with our systems and the failure of our systems. McKenna, was a drug that was used to prevent preterm birth for 20 years. And people often ask me, how did we inject pregnant women with a synthetic chemical compound, a synthetic hormone that didn't work? How did we do that for 20 years? But what happens is that there was a desire, having a preterm birth can be an awful thing for the mom, for baby, depending on how early the baby is. And so there's this desire to try to prevent it from occurring again. So the motivation there was good. But what was what they came up with was injecting this this synthetic chemical compound, the synthetic hormone McKenna 17 hydroxy progesterone into into pregnant women. And we've done this before. We've done this before in obstetrics, which is this idea of treating women with hormones to try to prevent problems. And what ended up happening, and what has always ended up happening is we ended up causing more harm than good. We did this with DES. DES is the drug people know in particular. And DES was really pushed over decades in the 40s and the 50s and the 60s. Millions of women had taken that. And later it was shown to not be effective, to not prevent preterm birth, to not lead to healthier pregnancies. And in fact, it was causing significant harm in fetal development, leading to congenital anomalies. So we made this mistake before and then in 2003, starting in 2003, that drug was approved. McKenna had a different name at the time, but the compound was approved. It was shown to be effective in one study. And that study was severely flawed. But at the time, the FDA was just using that one study to allow it to have provisional approval with the idea that a second study would eventually be done. So it was eventually given FDA approval and it was used, as I said, for 20 years. It was clear though from the get-go to me, I think, and to some others that the data didn't look good. The initial study had several flaws in it. It was called the MIS trial, M-E-I-S. That original trial had a lot of flaws in it. And when you looked at the numbers, you'd say, to base... Adam Urato (08:28.5) giving pregnant women, injecting pregnant women every week with a synthetic hormone based on this one trial really seemed badly thought out and turned out to be that that in fact was the case. As we were watching the data come out over the years, over that 20 years, several studies showed that it didn't appear to be helping. The drug didn't appear to be helping. Eventually, the confirmatory trial came out in 2019 and showed that in fact, it didn't work in the confirmatory trial. And so the second trial failed. And so eventually it was pulled off the market. That's another story in itself, though, because the trial was shown the trial that showed it failed was in 2019. And then it stayed on the market for another four years after that, which is really outrageous. I still hear from pregnant moms or moms who were pregnant during that time. 2020, 2021, 2022, who say, I had no idea this was all going on, that the confirmatory trial showed it failed and I was still being given these injections. So the big thing though that I noticed from that is that what happens with these drugs is once they get in the market, once they start making money, then that money is able to be used to drive a system of more promotion of the drug. the drug company is able to then sponsor, for example, key opinion leaders, physicians to go out and lecture on McKenna and tell people to use it. The money, the profits are able to be used to sponsor, for example, the American College of Obstetrics and Gynecology, the American Society of Maternal-Fetal Medicine, the March of Gyms, all organizations that can then promote that. So then you get this, like what I would call, the cash cycle, where even though the drug doesn't actually work, from a medical or a health standpoint, it does work from a profit generation standpoint, which is that the drug gets sold, generates revenue, the revenue can get poured into the professional medical societies, into the key opinion leaders, into other areas to promote it, which then leads to more sales and profits, which can then keep this positive cycle going. So that's why when I lecture on McKenna, I tell people that it didn't work when people say, how did you Adam Urato (10:46.474) How did we inject pregnant women with a drug for 20 years that didn't work? I say it didn't work in terms of medically or for health, but it worked in terms of profit for these bodies. And that's the problem. And we're seeing this again and again in our society with medications, vaccinations, and all sorts of other products that get pushed on the public for profit generation and not necessarily health. Roger K. McFillin, Psy.D, ABPP (11:17.678) Yeah, I think the question I get from a lot of patients and just people listen to this podcast, I know they have this question as they listen to this. There's like this assumption that these drugs go through pretty rigorous safety evaluation. And they don't fully kind of understand the reality of all this. I guess I wanna get your thoughts on, know, what would be rigorous safety evaluation? Why isn't that? considered like the first step in all of this before you even determine whether a drug is efficacious or not, shouldn't we first determine whether there's like good long term safety data in the population that we're going to use the drug for? Adam Urato (12:02.816) Sure, absolutely. That's exactly right. And I think just people ask this question like, why don't we have more safe drugs in pregnancy? But a huge issue there is that fetal development, embryonic and fetal development is so complex that adding a chemical into that mix of embryonic and fetal development will typically alter that development. So it's very difficult to get safety in that sense. This term also, whether something's safe or not, I tend to push back against that because I think it's a more useful model, a useful approach really to just take whatever it is and address the risks, the benefits, the alternatives, rather than trying to come up with a label of whether it's safe or whether it's unsafe. I think it's much more useful. It may sound silly, but for example, is driving a car safe? Yes and no. I think there's 40,000 motor vehicle deaths per year in the United States. So you could look at that and say it's not safe, but it is safe in the sense that it's something we all do. What's more useful to me than giving these labels is to actually talk about risks, benefits and alternatives. But we're coming back to like, how should these things be studied? How should they be looked at? And really the kind of study you need is longer term study where you do randomized controlled trials and then have long follow up because even though you may be able to address one thing or one parameter in a short term basis, you really need to ask questions about whether or not it's impacting long term health. And the reason for that is that these drugs, these medications that we're using, by and large, they're synthetic chemical compounds. And I always make the statement whenever I talk about this, but medications are chemicals and chemicals have consequences. In particular, chemicals have consequences for fetal development. They're going to have chemical effects. So even though with a medication, you may get some short-term benefit in one area, there can often be longer-term harms because there's a chemical impact throughout the body. We see this, you know, this literature better than I do, but with the antidepressant trials that Adam Urato (14:24.904) often look very short term. So you may get some kind of a small short term bump, but then you have to ask the question, okay, I'm getting this positive or good result in this one small area, but that chemical, that drug, let's say an SSRI, let's say Zoloft or Prozac, that's not just having some impact in the brain, that's affecting the platelets, that's affecting blood clotting, that's affecting bone health. So really for safety evaluation, looking at these things, it needs to be done with good randomized controlled trials. It needs to be done looking at long-term health outcomes rather than a single parameter. And it needs to be done in particular, not by the pharmaceutical industry, because we know that the drug companies are going to hide the data. They're gonna monkey around with the data. That's been shown time and time again. Probably one of the best examples is with Vioxx. Vioxx in the studies, it looked like people that were taking it in the studies. were having heart attacks. And to my knowledge of that episode, it looks like they just hid those patients, took them out of the data set so that that wouldn't be clear. It got FDA approval. And then lo and behold, what happened when we started giving Vioxx throughout the population is we started seeing heart attacks. That's another thing, and I'm rambling a little bit, but that's another thing the public needs to be aware of, which is that for a lot of this stuff, You, the public, are participating in an experiment of sorts. These things have never been done. We've never altered human fetal development with chemical compounds the way we are currently. So it's basically a fairly large-scale human experiment that we're witnessing right now with all of the drugs and chemicals and medications that we're giving to pregnant women. This is like the first time I would say in recorded human history where on a wide scale we expose developing embryos and fetuses to synthetic chemical compounds in this fashion. Roger K. McFillin, Psy.D, ABPP (16:33.068) And the big question that's going on right now, especially with Robert Kennedy, who is heading HHS, is what is driving the chronic disease epidemic in this country? What is driving the increased rates of neurodevelopmental conditions, autism, for example, right? And at the same time, as far as I can probably recall, or we can reflect back historically, is that we're seeing decreased lifespan, average lifespan in the United States. So we're an absolute sick country. And then when you start asking these questions or you start theorizing or the desires for more rigorous gold standard science in these areas, you see the pushback from politicians and those in the medical establishment who really are benefiting from the use of all these interventions, whether it's vaccines, whether it's psychiatric drugs or other medical interventions, there's this this threatening aspect of wanting to evaluate more so much so that we have politicians who, without a doubt, are receiving, you know, pharmaceutical money or lobbying based money for major corporations that are trying to prevent the further evaluation of these products. Adam Urato (17:49.898) Yeah, think that however people feel about Robert F. Jr., it's been a great service that we're now having this discussion, that we're now talking about the chronic disease epidemic in the United States. think whatever your politics, the fact that we've got this huge problem in our country with a chronic disease epidemic, with these skyrocketing rates of autism and other neurobehavioral disorders, the fact that now this is on our radar, has been a huge service to the population, to the country. And it's really crucial that we don't lose this opportunity to look at these things and focus on these things. Where I stand, I think about new fetal exposures. And as I was saying earlier, we're seeing so many more drugs and other pharmaceuticals being used during pregnancy. The issue of trying to study it gets complicated because then you're looking at outcomes like autism and how are you going to define that? Is it going to be that you're looking at profound autism? Is it going to be looking at that you're looking at more mild cases and then trying to correct for confounding factors? These things can get more difficult, more challenging when you're doing those studies, but the studies need to be done. But what I look at or what I focus on is that fetuses, embryos, young children are using brain chemicals to develop things like serotonin, norepinephrine, other neurotransmitters. And so certainly during the pregnancy time period, during the fetal time period, when we're exposing moms to antidepressants and other medications that affect those hormones, those neurotransmitter systems, there's going to be an effect of those things. When I make an argument on this, I try to boil it down to be very simple. So the way I usually lecture on this is that if you think serotonin, and I would say not if you think, but there's scientific agreement, the science on this is there's pretty much consensus that serotonin plays a crucial role in fetal development, in particular, fetal brain development. That's taken. We all agree on that. And if that's true, and if the second statement, which is that Adam Urato (20:14.266) SSRIs and these other chemicals affect the serotonin system, then that right there by definition is going to tell you that the SSRIs and other medications are going to alter fetal development. They have to because the serotonin system is crucial for fetal development. These drugs alter that serotonin system. So they're going to alter fetal development. And so knowing that and knowing what's going on at the pregnancy, with the pregnancy exposures, And then looking at what we're seeing in the United States and around the world with neurobehavioral disorders in children, it's absolutely a concern. What exactly is the impact of prenatal SSRI use or prenatal other medication use? And I can get into that with you think drugs like Zofran for nausea, which affects the serotonin system. What's the impact of that with all of the neurobehavioral problems we're seeing? That sort of thing needs to be studied. But it was very frustrating to me just to pick up on your point. A politician, I believe a politician from Minnesota had tweeted out that this is anti-scientific, I think is what she said. The goal of trying to study the risks of these medications, which are being used in widespread fashion, she labeled that goal or that approach as being anti-scientific. And this is completely absurd. There's nothing that could be more scientific than trying to study chemical medication that's being used in a widespread fashion across the population. Roger K. McFillin, Psy.D, ABPP (21:48.14) Yeah, well said. Before we get into the video, I want to show you, I refer back to the way that you communicate this, which is to identify risks, benefits, and also alternatives in the best way that you can in non-biased fashion, right? And that is the, that is supportive of an individual's rights to choose because it is a risk benefit analysis and to acknowledge that they are under a profound experiment. And there are chemical, there are consequences to the chemicals that are created in a factory. And not it's unnatural. Dr. Diane Hennessy Powell, who I had on this podcast, who does work with autistic savants. And I asked her the same question about the rise in autism and the chronic disease epidemic. And she just simply said, we have children born in an unnatural world. And so then taking a drug that's going to alter fetal development is unnatural, right? Now to the effect of this and what the mother is willing to accept given what her current state is, is another question. And so I do want to provide you an alternative perspective because we see this often. There are going to be physicians out there that argue that untreated maternal depression is more harmful than SSRI exposure. So that's the question. at hand right now. There is a influencer on Instagram. I am, I can say I'm biased to an extent that I have looked so deeply into this literature that I can't for the life of me be able to identify how a benefit could outweigh risks. So I'm going to say that's my bias coming into this. So her name is Dr. Kristen Lasseter, and I hate how platforming her because I think some of the information that she's that she's providing on this site doesn't support the literature and then she misrepresents that to the public. It's it's the reproductive psychiatrist, the period reproductive period psychiatrist, I'm going to play something that she has on her Instagram account. Adam Urato (24:52.64) I'm not seeing it, Roger. Roger K. McFillin, Psy.D, ABPP (24:58.008) Yeah, I'm sorry. I didn't share it. Okay, we'll cut all this out. I'm gonna have to start it again. Adam Urato (25:02.496) Yeah Roger K. McFillin, Psy.D, ABPP (25:15.726) Alright, I'm going to start this again. Adam Urato (25:17.652) Yep, no problem. Adam Urato (25:21.888) you Roger K. McFillin, Psy.D, ABPP (26:38.09) Okay, Doc. Basically, she's making the point that mental illness in itself is a risk factor to the baby. So there's something biological in this illness, and that you would take a drug which would treat that illness and then prevent that illness from impacting fetal development. So as a maternal fetal medicine doctor, want you to first if you could be able to tell us the range of of tests, objective tests that you do to detect the mental illness. Are there certain type of like fMRI, CAT scan, brain scans? What kind of blood work is going to identify this mental illness? Is there some genetic screening that's done that identifies this mental illness? And then after you provide the drug, are those follow up screenings then? demonstrated to treat that said mental illness and now we can protect the baby. Adam Urato (27:44.574) Yeah, I would want to give Kristin, I don't know Kristin Lassner, but I would want to give her the benefit of the doubt. She's trying to do the best she can to get a message out to people. think though, honestly, that, with that introduction, I think that's what you're seeing there is basically like profit-driven propaganda. This whole idea of what she laid out and what you were just getting into, like, do we have a good way of defining what the mom's mental illness is. And then this idea that we define what that is, and then we take a targeted therapy to try to eliminate that mental illness, thus improving the pregnancy environment for mom and baby, and then leading to improved health outcomes. This is what that message is, that we've got this almost scientific approach now to mental health and pregnancy, where we've got as you were touching on, getting into good ways of diagnosing it, good ways of following it, and then leading by this through this treatment to better outcomes for everybody. That's just simply not correct. That's not what we're seeing. For a variety of reasons. First off, we don't have good ways of being able to determine we don't have a blood test for it. We don't have other measurements that are that are going to be able to allow us to diagnose and then tinker with the levels of depression or anxiety and pregnancy. We don't have those things. And as far as the link between what she showed, the link between depression and poor outcomes, it's a very weak link if present at all for many of those conditions. When people have tried to do the studies on those, just doesn't look like the model that she's presenting, which is that We know these things are harmful, cause significant problems with preterm birth and elsewhere. Some of the studies do show a link, but even the studies that do show some link between pregnancy and adverse outcomes, to really advocate for the use of the drug, you can't just show that there's a link between certain mental health states or diagnoses and poor outcomes. And again, which many of the studies don't show that, you can't just show that, but you also have to show benefit from the use of the drug. Adam Urato (30:11.858) And in both those areas, that evidence is missing. If there's any difference in a lot of those areas, low birth weight, preterm birth, preeclampsia, several of the other ones, it's a small, they're small differences. And there's no evidence that use, there's no reliable evidence that use of the medication is going to improve those outcomes. And as I touched on earlier, what you end up with, what you end up with through use of the medication, is this ongoing chemical exposure to the mom and baby that we know has downsides. So in terms of risks, you get all the chemical risk from the use of the antidepressant. If you follow her model, what she's laying out there, you get all of the risks from the chemical risks from the use of the antidepressant. And what those risks are, are miscarriage, birth defects, preterm birth, low birth weight. preeclampsia, then at the end of pregnancy or at the time of delivery, a postpartum hemorrhage, which I can talk more about, and then after delivery, problems with newborn behavioral syndrome or poor neonatal adaptation. These are all the risks that come from using SSRI antidepressants during pregnancy. And we know this from a large number of studies. So those are the, and then there's the long-term risks. to the impact of the baby's development. Now you've altered fetal brain development and there's evidence from the studies that show increased motor problems, increased rates of depression and other mental health diagnoses in the children, in the offspring, and then autism and other mental health or neurobehavioral conditions. So you've got all of those risks with the use of the drug and we really don't have good evidence of benefit. The model that she's trying to show there is there's no evidence for that. Occasionally you'll find a study which is parsed in a certain way to try to show evidence, almost always, Roger, almost always in virtually every study, if you look at the chemically exposed group, the medication group versus the non-medicated group, you virtually always find poorer outcomes in the medication group. And so this whole notion that Adam Urato (32:36.69) It's like diabetes. If you correct the diabetes in pregnancy, control the blood sugars, you end up with a better, healthier mom and baby, that SSRIs work the same way. You correct a mental health condition and then you end up with healthier moms and babies. That's just not true. That's propaganda and it's not accurate. Roger K. McFillin, Psy.D, ABPP (32:57.134) Yeah, I'm going to take it a step further and I do appreciate your kindness and your professionalism to Dr. Lasseter. I'm not going to be as kind. So first of all, this idea that when we have mental health diagnoses, that they are discrete, legitimate medical conditions, that is a falsehood. So she's already miscommunicating that we can compare an illness like diabetes to a mental health conditions. These are labels. We don't have a disease called depression. We do have symptoms that we label as depression, and there's a myriad of potential causes for that that include undiagnosed medical conditions. Same thing with what we label as bipolar. We're in this interesting world of metabolic psychiatry right now, which is fascinating because you're targeting these symptoms with shifts in diet and amongst other probably lifestyle changes. And then you see, of course, the decrease in those symptoms. So there are these like legitimate manifestations that we have to be concerned about, especially if you're going to be monitoring a pregnant woman with their mood. But the fear tactics, the fear provocation that you have this illness and if you don't treat it with a drug, then you're going to actually affect your baby. is not accurate. And why it's going to be difficult for us to be able to identify a link in the manner in which he was saying is because we don't really have this universal accepted way of saying that there's a mental illness. They're umbrella terms. Depression is really an umbrella term. We give it to people who are going through just temporary sadness, but you know, also people are going to go on an SSRI who have some gut dysfunction and struggles with other aspects of their health or maybe undiagnosed conditions. It's just such a large, unbrewed term. And so her platform exists under this idea that there's mental illness, it's a discrete medical condition, and she is there as an expert to treat it. Adam Urato (35:07.348) Yeah, I think your point about the fear mongering is also a good one. I do hear this from patients. I see patients every day. I do hear this from time to time, this idea or their concern that is my mental state, is my anxiety, is the depression, is some of these feelings that I'm having, is this of direct harm to the baby? And I do try to remind my moms that the patients I take care of, we don't want anyone suffering or doing poorly. So there's always compassion and sympathy involved. But I do try to remind them that throughout human evolution in the mammalian world as well, pregnancy can be a time of stress. mean, for mammals in terms of worrying about predators and things like that, getting enough food. But over time, the humans have compensatory mechanisms and resiliency to be able to handle much of that stress. So this idea that every pregnant woman should live her pregnancy in fear of her emotions, and that if she's feeling stress, that she's doing all of this harm to the baby, that is not accurate. And it is something that would be a message that might drive people towards treatment of those things, which as I said before, is like the profit driven propaganda aspect to it. But this idea that women need to be afraid of their emotions, their regular human emotions during the pregnancy because of what that's doing to the baby. is a bit far-fetched. And most moms are able to manage through the ups and downs that occur in any pregnancy. And there are, as I said, compensatory mechanisms. There's resiliency for humans in getting through those things. What's new, though, for pregnant moms, what's new and significantly harmful are the chemical exposures. Those haven't been there throughout mammalian development and human development. Those are new novel exposures to the pregnant mom and to the developing baby. So I'm going to step back for a second and just talk about the postpartum hemorrhage in this context. That represents a threat to moms. We know that serotonin, SSRIs, and many of these drugs block the serotonin transporter. Adam Urato (37:28.224) Platelets are these cell segments throughout the bloodstream that are really crucial in clotting and making sure people don't hemorrhage, a person doesn't hemorrhage. When a mom takes an SSRI antidepressant, her levels of platelet serotonin go down dramatically. And I don't just mean like a little, I mean, it's like eight to tenfold. There's a lot less. If you check a mom on SSRIs, If you check her platelet serotonin levels, you find dramatically decreased levels of platelet serotonin. That likely alters or impacts the ability of those platelets to function to prevent hemorrhage. We see higher rates of postpartum hemorrhage. And in fact, the FDA is now warning about that. We also see increased rates of hemorrhage just in general in patients that use SSRIs. So that's an example where Is the mom's depression going to lead her to have a postpartum hemorrhage? No, there's not really evidence for that. You may get a one-off study here that suggests towards that and other studies that aren't finding that, but for the most part, no. But the chemical exposure is going to increase her risks of that complication of postpartum hemorrhage. And I would say in a similar fashion, many of those things that Dr. Lassiter was laying out, preterm birth, birth, excuse me, low birth weight and the other complications, very weak association, if any, to the mom's mental state, but a significant association with the chemical exposure, which is causing chemical effects in moms and babies and increasing rates of preterm birth and other complications. Roger K. McFillin, Psy.D, ABPP (39:14.574) said something critically important I want to go back to and it's regarding fear provocation and this can help transition us to informed consent and the challenges I think that exist for you in your role. So I had this great conversation with a woman yesterday and she has a medical background. She unfortunately went through a traumatic loss, pregnancy loss and is pregnant again. And the medical provider she was working with during the pregnancy loss referenced her stress as a causal link potentially to the loss of her baby. And so you can understand what the consequences of that might be is that now she's pregnant again, she has a fear of her own emotions, a fear of her own mind. So there's the fear of fear because she believes that's fatal potentially to her baby or to affect her baby in these negative ways. We got into this great conversation about how resilient the human capacities are. And just to talk about what we've had to go through in order just to be here right now. All the ancestors that had to survive long enough to procreate and the wars, the famine, the immigration, the real legitimate life and death stress, and then a mother's built in natural capacities to be able to protect that baby. So one of the things we're seeing in mental health That is new. This is relatively new that you see fear provocation from the physicians to put them on a drug to minimize their emotional reactions or to slow down their cognitive processes. So let's assume that there is some, a sedative aspect to multiple psychiatric drugs, or let's say there's emotional blunting is induced and that in itself is viewed as therapeutic. Essentially though, what you are creating is a mother becomes afraid of their mind and of their emotional experiences and stress. So when they present to you with that concern, I'm curious to know how you might respond. Adam Urato (41:29.086) Yeah, I think that this is a big challenge and it's part of the challenge of living in like a society where big pharma plays such a huge role. Fear sells, fear helps to sell things. And so by having people afraid, afraid of these things, afraid of these emotions, you can scare them into use of pharmaceuticals. the... Drug industry plays a huge role in terms of advertising on TV. It affects the news that we hear. And so I think these things are there to try to push us towards sales. I just try to remind my patients also what the research shows and of their own strength. I mean, I see strong pregnant women every day in my office who are making their way through their pregnancies and taking care of their kids. and have a great deal of strength. And I try to remind my patients of that and not to be afraid of these sort of campaigns that are out there to create fear, which then is being used to sell. That's also being done across the board by pharma. Always, know, what they've been doing is often selling sickness or selling the illness. And this is true, certainly with a lot of the pharmaceuticals, the vaccines, this idea of pushing like you could die, you could be dead tomorrow if you get this disease. So you've got to do, you've got to do what pharma wants. This, this, pushing of that. You can't rely on yourself. You can't rely on your community. You've got to be afraid of your own emotions. You've got to be afraid of everything. It tends to drop it. The idea is to drive that towards people typically. using pharmaceuticals or other policies that those in power kind of want people following. So I think when I have these discussions with patients, I just try to remind them of their own strength and we have a full discussion for how they're going. Every case is different. And then if it comes down to whether or not a drug should be used, making sure that we're having that good discussion about, again, the risks, the benefits and the alternatives. You say often in this podcast that Adam Urato (43:47.384) You can't give informed consent unless you're informed. And that's so crucial. I have so many women still coming into my office who tell me that the only counseling they've really had is that the SSRI, the Zoloft or whatever they're on is safe and doesn't affect the baby. And that's often the extent of the counseling that they're getting. And again, I try to get away from that term safe or unsafe for the reasons I said before in the fact question of whether it alters or affects the baby, it does affect the baby. Absolutely. And there's scientific consensus on that. As I say, I always try to make that point. This isn't some some doubt or question. There's scientific consensus. And in fact, I'm trying to work now on getting the label changed for these drugs so that it's more clear that these drugs are affecting the development of the fetus, in particular the fetal brain. And again, that they alter fetal development and they must alter fetal development because we know These systems are crucial to fetal development and we know that these drugs affect those systems. Roger K. McFillin, Psy.D, ABPP (44:51.246) Yeah, and we're going to get into that. That's going to be a highlight of this podcast is what you are doing to try to get the label changed. But before that, the last time you were on here, we were talking about these steroidal antidepressants. I think one was Zersave, Zersave, right? And there's another one, Zolresso, I think. And this goes back to the fear provocation, because if you can manufacture this disease and you manufacture fear, then you have a treatment to sell to somebody. but the risks of that treatment were so significant, meaning like unable to drive a car. And how do you take care of a baby when you're under that type of altered state of consciousness, like it has that type of consequences, let alone all the adverse effects of all other antidepressants and then passing it through the breast milk, right? So we now have to get into talking about informed consent, right? We know that in most hospital centers, it's something you sign really quickly before you even meet with the doctor. It's kind of almost attesting to the fact that you were provided informed consent. But the standard is much higher than that, ethically, for you as a physician and for me as a psychologist as well. When you do come across a pregnant woman or woman who is certainly in the early stages of pregnancy or wants to become pregnant, they're on an SSRI or they desire to be on an SSRI or other psychiatric drugs. How do you communicate to them the risks and the benefits to start and then we'll get to alternatives? Adam Urato (46:36.084) Yeah, I think this is absolutely crucial that conversation that we have to have. And I think to give my colleagues, to just explain it, I do think that I try to look on the good side, Roger, of humanity and my colleagues. do think the docs I work with want to do their best by their patients. But I think part of the problem that a lot of providers are up against these days is the time limitations. there's a limited amount of time in an office visit, certainly in an OB office visit, a prenatal visit, to try to go over these things. And so honestly, the quickest way to get through a visit when a patient's on a medication is to say something like, it's safe and effective and you can take it in pregnancy. And then that would move along to the next patient. And so this is a problem in our whole system. not just for taking care of pregnant women, but in general, that's why it's hard to do the informed consent because it really takes time. I'm fortunate as a specialist that I have more time with patients. So I'm able to actually spend the time with them and go over these things. And I'll go over that in a sec. But I just wanted to give a little anecdote. I lecture on this many years back at Tufts, speaking with the department and the fellows. And one of the fellows at the time who didn't have much of a filter, I finished my lecture and she said something to the effect of, my God, if I actually believe what you're saying, I actually put that in practice, I could never get through my day because it takes a significant amount of time to be able to explain these things to patients and be able to really go over it with them. But I think it's crucial. So guess one thing that I'm saying is I think a lot of the informed consent conversations not going on not because doctors and OB providers don't want to do that, but because simply the time pressures in practice nowadays. What I usually do with my patients when I see them in the office and we have this discussion is I first try to figure out where they're at, what their mental health history is, how they're currently doing, et cetera. And then I try to make sure from the gate that they understand that it's not a, this conversation is not about pill shaming and making them feel bad and that sort of thing. Adam Urato (48:54.954) I try to support patients. do tell them that we don't ignore health issues, whether it's hypertension or epilepsy or depression. We don't ignore mental health issues in women just because they're pregnant. So they'll understand that we're not going to ignore what they're going through or what they're talking about. And I also try to broaden the discussion to explain that this isn't just about mental health medications, but more broadly, it's counseling that can apply. to medication use in pregnancy in general. And what that counseling is, so for example, if you've got a patient with hypertension, we don't tell the woman, you're pregnant now, so you can't be on a blood pressure medication, you just have to have out of control blood pressure and stroke. We don't tell them that. We will control that. But what we try to do with blood pressure in pregnancy is we try to use the lowest doses the fewest number of medications, the shortest period of time, but while still taking proper care of the mother. So that becomes then the rule of thumb. You want to use the fewest medications, the lowest doses, the shortest period of time while taking proper care of the mother, including not taking any medication at all. And then I try to work from that general framework, which would apply to any medications to their specifics with the drug, with the drug that they're on, and then review or go over with them. the various risks. And then the benefit I'll get into in a sec, but the risks I typically go over with them are the ones that I've laid out earlier, which is risk of miscarriage, risk of birth defects, risks of preterm birth, risks of low birth weight, risks of preeclampsia, a disease called preeclampsia, postpartum hemorrhage, and then newborn behavioral syndrome, also called poor neonatal adaptation, and then long-term effects, long-term fetal effects. including things like neurobehavioral problems, well as gut or gastrointestinal problems, which have been shown to be more common and more frequent. So we go over those risks. In terms of benefit, the benefit discussion with a patient for these things can become challenging because the evidence, the medical evidence, which I know you've gone over on this show numerous times, the research evidence isn't great for showing a clinically significant benefit. Adam Urato (51:17.64) Many of those studies were just done over short time periods. Many of them did not show any benefit for mental health. The long-term data trying to show that it has long-term benefit is basically absent. The STAR-D trial that was originally used to try to show that, that's been shown to have many problems. And there's a lot of controversy about that, the way the data was monkeyed around with. So there's not particular benefit in that sense. but for a given patient or an individual patient, one of the benefits to them can be the avoidance of withdrawal. And that is an interesting area because about half of pregnant women, when they come in, about half of pregnant women coming into pregnancy will stop their antidepressant. And it's an interesting phenomenon because of that half that stop, many of them appear to be able to do okay. That's typically not what's recommended. Now the movement is towards tapering, hyperbolic tapering, et cetera. You can discuss this better than I can. But many pregnant women, when they find out they're pregnant, will stop. It's roughly half. And many of them will do OK. And some of them do very poorly. And so for a given woman during her pregnancy, where she's at, the dose that she's on, her mental health history, that benefit for her maybe in continuing something that she'll have significant trouble in coming off of. And so that's a discussion that I have with them about what that would be like, tapering, staying on, how she wants to manage that. And so that becomes the benefit piece to it. So I guess to summarize, not real evidence of benefit for these medications, at least from the studies that are out there, but benefit in the sense of avoiding withdrawal for the mom. And then alternatives. talking about good approaches to mental health in terms of some of the issues you were talking about earlier. You can do psychotherapy, you can do exercise, nutrition, proper nutrition, importance of sleep, which as we study it more, is realizing it's more and more crucial, trying to optimize these things, your relationships, what you're doing, the meaningfulness of your work, sun exposure. Adam Urato (53:35.37) There's a lot of other options or a lot of options to really help with mental health in terms of what those alternatives are. And so this, as you can imagine, though, from just hearing me go over it now, is a lengthy discussion. Going through those risks for patients in terms of what is preeclampsia, why do the SSRIs increase preeclampsia, what is postpartum hemorrhage, why do they increase postpartum hemorrhage, poor neonatal adaptation, what does that mean? That can mean the baby's being restless. agitated after birth, higher rates of going to the NICU. This is a long conversation with patients, but it's one that's really important. And then at the end of that, I tell the patients what you decide I'm going to support you on because they're my patient. They're a mom typically in my community, the community that I grew up in, that I live in, I'm going to support her and I'm going to be continuing to see her through that pregnancy. for ultrasounds, figuring out how the baby's growing, how things are looking. And I want her to know that I'm in her corner, I'm supporting her for the remainder of the pregnancy and that we're gonna kind of try to work through this together. Roger K. McFillin, Psy.D, ABPP (54:42.146) Doc, my head almost blew up when you told the story about the woman who states that she doesn't have enough time to provide anybody informed consent. And it's just so much easier just to tell them it's and effective. So, you there's certain things I learned when I was four years old. And I think I taught my kids that. And I think we have this way of overcomplicating a lot of things. And I've heard this so many times from doctors who are able to justify their Adam Urato (54:53.632) You Roger K. McFillin, Psy.D, ABPP (55:11.79) inability to be able to provide informed consent by the time restrictions that they have. You know, the thing here is the the golden rule. I mean, I learned this when I was pretty young. You know, it's it's pretty much like you treat others the way you want to be treated. And in other things that was like really important that was taught to me and I tried to teach it to my kids is don't lie. Don't mislead people. Right? Adam Urato (55:35.826) It's a good one. Roger K. McFillin, Psy.D, ABPP (55:37.48) you do those two things in life, you're probably going to be trusted, you're going to have some really good relationships, you're going to live a life of honor and integrity. So I was just looking at the time as you were kind of going over informed consent, right? And what's fascinating is you keep talking about how long that is, it was less than 10 minutes. Like, this is like somehow drilled into the minds of modern medical professional that my god, you can't have 10 minutes. to say that if you take this drug, it could have potential long-term consequences on your fetus, on your child. You can lose your child by taking this drug, but my God forbid we don't have 10 minutes. And the other thing is, think, I'm pretty sure it's 2025 and we have like technology, like there's podcasts or you can actually record informed consent onto something and send it to them on their phone. So even if you don't have that you can like provide them informed consent, they can listen to it, they can listen to a podcast. And this is how dumb I think we've all become. Like we're, we're just supposed to accept and walk away like, damn, not enough time. Safe and effective. Hey, it's on the vaccine schedule. It's got to be safe, right? Like Adam Urato (56:48.21) I'm Adam Urato (56:54.012) You Roger K. McFillin, Psy.D, ABPP (57:03.04) Yeah, try when has our government or any government in world history ever failed their citizens? So we just can't be that dumb anymore. And then I want to add in this this other piece. This is from Dr. Andrew Kaufman, who I've recently found I find him fascinating. I think he's really smart. He's actually a psychiatrist. And he posted this today or yesterday. The US economy is heavily dependent on the medical industry. Adam Urato (57:08.283) Hahaha Roger K. McFillin, Psy.D, ABPP (57:31.05) If we truly divested from it, it would trigger a massive economic shift. Just look at how many new industries were created during COVID. Now imagine that level of expansion and transformation playing out over decades. So one of the things that is happening here, and this is hospital administrators, dean counters, who say you have to see this many patients in this amount of time is They have the power apparently, but they really don't. We don't need hospital administrators, we don't need bean counters, but we need physicians. You have all the power. Every physician that's listening to this, you have all the power. They can't survive without you. Fuck them, right? This is about informed consent, but this is also about your personal integrity, right? And here's the thing is when you go to any ethics seminar or take any ethics class, Ethics supersedes law. It supersedes law. You can violate the law. Get yourself a lawyer, lawyer up if it interferes with your ethics. If it breaks your ethical code, like if it interferes with your ethical code, then you have the right and responsibility then to fight the law. And that's part of the problem that exists is, is there's just there's this fear and dependency that physicians have. It's such a system that's created because they're in tons of debt. They're beholden to the system and they just follow it, right? And this is corporate medicine where now they just follow these protocols and we've lost the independent physician. Adam Urato (59:10.648) This is a huge problem. Absolutely. I'm an independent physician. I own my own practice. And I think it does create freedom, freedom to speak out on these things. I think it's difficult. I think that that move towards corporate medicine has been a huge problem, just for a large number of reasons. But in particular, I think there is a concern for a lot of physicians with speaking out on these things. We're also not kind of going along with whatever the protocols are. We're seeing at least in my neck of the woods up in Massachusetts, a lot of sort of a handful of groups, hospital-based groups or corporate groups that own the doctors, have the protocols. And it really changes, I think, a physician or providers relationship to their work, relationship to their patients, and also their capacity to kind of be able to really say what they want. And I do think it's a major problem. I do agree with you though that we've got to make changes and healthcare providers, physicians need to really band together on this because we're the ones taking care of the patients and there's been this explosion of administrators and I don't want to make this sound like an us versus them scenario but you've got this system that's really run out of control to the detriment of the physicians, to the providers and to the patients. Roger K. McFillin, Psy.D, ABPP (01:00:35.628) Yeah, it's like something happens when you all go to medical school. I think you grow into some conditioning camp or something where you're afraid to speak out against each other. Like, like even, even today, like you're so kind to, to that reproductive psychiatrist. I've gotten, I've gotten into this with, my, one major problem with Dr. Christopher Palmer. And listen, I love the work that he's doing. I think it's innovative work. think it's exactly what I think we should have psychiatrists do is advancing the field and recognizing that the. interventions that we're providing cause much more harm than good. But boy, he's like scared to death to speak out against psychiatric drugs, because that's most of what his profession does. So he just won't do it. And he'll say nonsense, like, you'll hear him say, we have all these great drugs that serve so many people, but we don't help everybody, right? And I'm like, are you kidding me? You know, I had him on my podcast, too. And before we came on the podcast, he was like, don't have me talk about psychiatric drugs, right? What the fuck, Doc, you're a psychiatrist, that's all you do. All you bring to this entire healthcare profession is that you write out drugs, It's like this fear of being outside the tribe and being critical of the tribe. And we just need, we need these ethical medical professionals like to stand out from their tribe and be critical of what's happened. Adam Urato (01:02:10.09) Yeah, and I want to jump on that because I think it's crucial. I try to be a happy warrior in this process. I think at the start of my career, I had more sort of bitterness or anger. I still have that element to it. And believe me, I love your passion. I absolutely love your passion. I try to look kindly at my colleagues and the scientists on these things and even the pharmaceutical professional. I try to look kindly upon them while still fighting the fight. I have no trouble speaking out against these drugs. I think it's really important though, getting back to what you're saying, it's really important that we encourage voices of dissent in our society because many times or most of the times those voices are correct and that turns out to be what's right. And I've been doing that in obstetrics now on a variety of topics, not just antidepressants, but as we touched on earlier, I spoke out against McKenna. After McKenna, for a while the pharmaceutical industry and some of the larger groups, the makers of blood thinners were trying to get us to put women, every woman having a C-section on blood thinners with the idea that we needed to prevent blood clots in everyone. And I argued against that. And during that throughout my career, I've often found myself feeling like, where is everybody around here? Why isn't everybody fighting this? Roger K. McFillin, Psy.D, ABPP (01:03:31.438) . Adam Urato (01:03:34.996) But sometimes, you know, everybody doesn't fight it, but it's important to have people who are raising their voices. And so I would encourage people to one, speak out, and number two, support people that speak out. And this gets to my whole, like, passion for freedom of speech and against censorship. What we saw, I think, during COVID and subsequently has been a very, very dangerous trend in our society where there was a large amount of censorship going on where people were really being clamped down on that wanted to say things that they felt were truthful about the policies, et cetera. And we saw people being deplatformed and we saw professional medical societies and various boards of medicine threatening to take away physician licenses. This sort of censorship and punishment of dissenting voices is so dangerous. It's so dangerous to our society and to us as humans because the way we're gonna learn and get better as a human community is to talk through these things, hear dissenting voices, hear what people have to say, collect the information. And part of that is not censoring, is allowing freedom of speech. So I'm really an impassioned advocate for those things. Roger K. McFillin, Psy.D, ABPP (01:04:53.334) Yeah, amen. I love what you're doing. And let's get into why we really came on today's program because it is about a citizen's petition. Before we talk about what you're attempting to do, you posted about this. I spoke about it and have posted about it. A federal court recently dismissed a lawsuit against the FDA over its failure to respond to a 2018 citizens petition regarding PSSD, which is post SSRI sexual dysfunction warnings. So despite the FDA being legally required to respond within 180 days, they hadn't acted in six years, yet the court ruled the plaintiff lacks standing to bring the case. which is fascinating. Now, I think that under maybe current FDA leadership, HHS leadership, there's a much greater opportunity for this. But can you make a comment on what just happened and tell the listening audience here what you're planning on doing and how we all can be involved? Adam Urato (01:06:04.938) Yeah, I think that particular case with PSSD, the court was making the argument that the scientist himself, I only know through my Twitter connection with him, but that the scientist himself wasn't harmed, doesn't have PSSD, so doesn't have standing. It seems to me that it's a way of sort of kicking the can down the road or just avoiding making a decision on that. It's really important. On that subject in particular, I feel awful because I know that community follows a lot of what I do and responds. that condition, post SSRI sexual dysfunction is obviously awful and also speaks to what I talk about in terms of chemical impacts, chemical impacts on the brain, chemical impacts on the genitalia. yeah, it's awful. And really that didn't make sense to me. It seemed like it was the judicial kicking the can down the road saying that the the scientist because the scientist himself didn't wasn't harmed, didn't have standing to bring that. Hopefully, as you said, the new FDA, the new leadership is going to be friendlier to these petitions and try to jump on some of these things. The main issue I'm working on in this is I'll talk about the petition and also one more is is trying to get the FDA to change the labeling. I think that would be a real crucial step in terms of bringing awareness to the public, to providers and the public of the impact that these drugs are having. I'm focusing or we're focusing in particular on the impact on the brain. There's widespread impact on the fetus obviously, but the data is probably best on the brain in terms of showing that there are alterations in development with the use of these drugs during pregnancy. And we see this because If you do basic science studies, they have these things called organoids now, which are sort of basic science models of brain and brain formation. And you can see where exposing them to an SSRI impacts that brain formation in like a model. We can actually see it down to the neuronal level, down to the neuron. There's a study I tweeted about back a few years where if you look at a neuron, Adam Urato (01:08:30.772) You should see this nice cellular body with a bunch of axons, dendrites, a lot of things branching off of it. That's the way the neurons should look. As you treat neurons with increasing doses of Selexa, in this case of this study, you see fewer and fewer branching. They look very abnormal. So we know that the drugs impact the cells, the cells of the brain. We know from these basic science organoid models, we know that there's brain impact. When we look at animal studies, we also see this. If you treat mice during the critical time period, which would correspond to human pregnancy, if you treat them with SSRI antidepressants, you end up with alterations in their brain and in their behavior. They have different sexual behavior. They'll have different social behavior. So we know there's impact there. And then going to the human data, we're also seeing that the... impacts on neurodevelopmental problems. And even now what's being done are these MRI studies where we've got now, I believe the latest count on them is 10, that's looking through MRI studies at the human brain. This is after delivery during the infant or child period, after exposure to these medications. And we're seeing differences, differences in functional connectivity on the functional connectivity MRI studies and also some structural differences. as well as the impact that we see immediately afterwards with the poor neonatal adaptation, rates of poor neonatal adaptation are put as high as 85%. Now that sounds hyperbolic. You may say, geez, Urato came on and quoted up to 85 % for poor neonatal adaptation. But if you go to up to date right now, up to date is a common online textbook used by a large percentage of the medical community. That's what up to date quotes. that rates of poor neonatal adaptation after the use of SSRIs in pregnancy are as high as 85%. So we know from all of this data that I've just described that the drugs are having an impact on the fetal brain. We just need to change the labeling. We just need to change the FDA labeling to get that there. And that will also help change the conversation, which is what we've been talking about this morning. This conversation so that people will, the patient, the physicians, Adam Urato (01:10:53.29) the obstetrical providers will need to actually include that in their counseling. Patients just need to know that this is the medication and that one of the risks, one of the things we know is that they alter fetal brain development. And this is something that's shown now as I just laid out the evidence for it. So getting a labeling change, trying to get that, which hopefully the FDA will do, we just need to get our petition. Once that gets submitted, the way people can help is by... joining along, believe you can actually sign a support or send something in for support to the FDA to try to build momentum to change the labeling on these things to make it clear the impacts that these drugs are having on the fetal brain. Roger K. McFillin, Psy.D, ABPP (01:11:35.702) Okay, I mean, is there something that we can direct all our listeners to? Will there be a link that I can post in the show notes to this episode? If someone can go to sign something, how's that work? Okay, there will be, all right. Adam Urato (01:11:46.368) There will be, there will be, yeah, there will be on the way. And then the second thing I wanted to say is that, that I'm working on, was interesting because you made that point that we live in an era of technology. You could record your informed consent discussion. You could have something that you could give to the patient. I'm really working myself now on trying to pull together a document that physicians, other OB providers, midwives, et cetera, I tend to say OB providers because we have physicians, midwives, nurse practitioners, etc. providing care during the pregnancy period, but something that people can can use now. And that's in the works. And I will hopefully get around to that getting that out and disseminating that so that we can compete with some of these other expert statements that are put out there, or some of these other algorithms that are put out there, which similar to what you heard Dr. Lass that are saying kind of drive everybody down towards the model of using medications in pregnancy. I'd like to kind of lay out some of what I said here into a more digestible form, a one-sheeter or something that we can use then in the offices to try to compete against, again, what I call this profit-driven propaganda from the pharmaceutical industry about what these drugs are actually doing in pregnancy. Roger K. McFillin, Psy.D, ABPP (01:13:05.624) Yeah, my dream and I'm about to launch the Conscious Clinician Collective. We're literally weeks away because we're just finalizing the technology around this, which is to really create a searchable database of all clinicians who really do value informed consent and medical freedom. And you know that if you go see that person, you're going to be provided transparent and honest information. But if we're going to grow, a movement around informed consent. You know, I'd love to have a podcast or media that's tied to it, where we bring two professionals who might have diverging views and have a conversation about what the research is, because we grow from that, we learn from that. Like, I would love to have, you know, the reproductive psychiatrist to come on and have a conversation with you professionally, right? Because Adam Urato (01:14:01.322) Yes. Roger K. McFillin, Psy.D, ABPP (01:14:02.914) We grow from that. Now I'm not the best person to have that conversation most of the time because what's embedded in my mind is the kids that died by suicide after the drug and me sitting with the parents. So there's an advocacy part for me where I'm supporting all those people that have been harmed by those drugs. And I don't think there's a viable discussion around antidepressant safety and efficacy. I just don't believe it exists. I've never met one person who would be willing to accept permanent sexual dysfunction, along with a myriad of also other potential problems associated with the drug for a drug that has barely if that outperformed a placebo. And we have this range of other safe, more effective ways of dealing with the distress of living. depressed states of mood, challenges postpartum, during pregnancy, we have these range of safe and more effective approaches. So who in their right mind, if they were really informed of the risks, would take that risk? And the answer is nobody. know, the answer is nobody. feel so strongly about it. It took a long time for me to get to this point. I tried to convince myself otherwise, because there's just so many widespread users of these drugs and are being provided. And for me to face that, and to have to accept that as truth mean it had what it meant is that a narrative that I had or a fantasy I had about the healthcare system and about my life had to first disintegrate and had to be rebuilt under new information. And you face that dissonance and it's really, really hard. So not a lot of people want to do that. We want to believe that everyone's good and what's being done for us is in our best interest. But once that narrative comes to crumble, and you're faced with the reality of what's happening, and then you open your eyes to atrocities that have gone on throughout history, you have this radical acceptance of the challenges that human beings go through in this life, in being able to be honest, and how we are influenced by bias media, cultural narratives, and flat out propaganda. And it's so uncomfortable. Roger K. McFillin, Psy.D, ABPP (01:16:21.314) to be able to face that. It's so much easier to say, no, think most people are doing the best they can and they're doing a really good job. then, like I know this sounds so negative and difficult, but my assessment of people is most people don't wanna step outside the herd. They don't wanna step outside the tribe. That is what's threatening. And I don't see that as our highest human potential and abilities. And so that's where I'm struggling. But I know people will really benefit from the long form discussions and debates and nuances. And they require that. And I do believe most people are good and they want to do what's the best that they can. But the environment has to support it. The job has to support it. The culture has to support it. Your profession has to support it. or it makes it so much harder for them to step outside of that because most people have families, have kids themselves, right? They wanna protect them first and foremost, right? And they have a life that they're trying to lead. And that's the perspective that I come from. Adam Urato (01:17:33.076) Yeah, I applaud you for everything that you're doing and also bringing this collaborative together. And I think that those discussions are absolutely key. And in fact, I think this, podcast, phenomena of the podcast, this is so crucial for human progress and development because what was happening before this movement, before this technology, before podcasts is the only way docs like me could get the word out would be person to person. And what was getting out to the public, sort of the public messaging on this was always what was coming from the corporations, the pharmaceutical industry, and these large entities. So the speaker of truth back 30 years ago was really drowned out in a sea of what, as you said, what really amounts to propaganda in a large variety of areas in our society, whether it's the military, industrial complex and others, but certainly as as related to drugs. But now with these podcasts, we can get physicians like myself and others who are able to speak the truth in an area which doesn't sell any product and actually, in fact, works against the sales of product, but can get that message out. to a large number of people. And so I think it's crucial. You often say on your podcast things like, share this, spread this around because we really need enough people to hear this. yeah, you've had so many great voices on your podcast, Robert Whitaker and Laura. know you just interviewed Laura Delano with her new book, Kim Witzak. These voices getting out there, doing the podcast, spreading the word. getting that pastoral, that gets that message out in a way that we never could before. And so I think it's vitally important. And I would welcome the opportunity to debate anyone at any time on this. I sound like one of those prize fighters. I'll take on anyone anytime, but I'm happy to debate this. And it's a point that I make going back to the basic science, there really is no scientific debate on this as far as whether the drugs affect. Adam Urato (01:19:53.824) developing fetal brain, you won't be able to find an embryologist that comes on here or a psychiatrist that's going to say, you know what, they don't appear to alter fetal brain development. That's just not there. No one can make that argument. But I would be happy as you get the collaborative launch to participate and also to debate this and these long form debates and talk it out and talk through it. Roger K. McFillin, Psy.D, ABPP (01:20:16.546) Yeah, definitely. Amen to that. I'd love to have Dr. Lasseter join the podcast in good faith. Listen, the thing I'll support the most, even if you disagree, have an alternative perspective. What I do is I respect your courage and your willingness to enter into the conversation. And so if she's willing to put herself out there on Instagram, so I'm sure she believes in certain things to be true and she believes in her training. You know, those who are listening reach out to her. And for her to come on, radically genuine to start, I'm going to reach out to her as well. She deserves that. We spoke about her today. She deserves that opportunity to be able to defend her positions. But it'd be really challenging, Dr. Urata, to step into the ring and debate you. You're so smart, you're so well spoken, and you've just put the time in. I mean, you just have such a thorough grasp of the literature, and your heart is in the right place, and you're independent. Right? It's like, so you are a huge threat to people who are working within the system. It'd be very difficult to enter into that conversation with you. Listen, I want to thank you so much for coming on the Radically Genuine podcast. I mean, it was a great show. What I want to do is encourage everybody to follow Dr. Urato on X because he's posting this. he's, posting his thoughts. He's posting literature. It's at Adam Urato one. That's at Adam Urato. U R A T O. one, it'll be in the show notes, please follow him. He's incredibly influential in this field. And in the Make America Healthy Again movement, he should be the go-to around drugs and pregnancy. And I'm going to make it my mission moving forward that more people are aware of. his work. So, Dr. Urato, want to thank you for a radically genuine conversation. Adam Urato (01:22:17.95) Well, thank you very much. really appreciate the opportunity and all the work that you do on this. Roger K. McFillin, Psy.D, ABPP (01:22:21.774) Thank you.